††††† NECESSITY, FUNCTION, AND CONFORMITY: The
Cabinet for Health and Family Services, Department for Medicaid Services has responsibility
to administer the Medicaid Program. KRS 205.520(3) authorizes the cabinet, by
administrative regulation, to comply with any requirement that may be imposed
or opportunity presented by federal law to qualify for federal Medicaid funds.
This administrative regulation establishes the Medicaid Program provisions and
requirements regarding the coverage of audiology services and hearing
instruments.

††††† (2) "CPT code" means a code
used for reporting procedures and services performed by medical practitioners
and published annually by the American Medical Association in Current
Procedural Terminology.

††††† (3) "Department" means the
Department for Medicaid Services or its designee.

††††† (4) "Enrollee" means a
recipient who is enrolled with a managed care organization.

††††† 2. Before initially enrolling in the
Kentucky Medicaid Program, submit proof of the license referenced in
subparagraph 1 of this paragraph to the department; and

††††† 3. Annually submit proof of the license
referenced in subparagraph 1 of this paragraph to the department.

††††† (b) An out-of-state audiologist shall:

††††† 1. Maintain a current, unrevoked, and
unsuspended license to practice audiology in the state in which the audiologist
is licensed;

††††† 2. Before initially enrolling in the
Kentucky Medicaid Program, submit proof of the license referenced in
subparagraph 1 of this paragraph to the department;

††††† 3. Annually submit proof of the license
referenced in subparagraph 1 of this paragraph to the department;

††††† 4. Maintain a Certificate of Clinical
Competence issued to the audiologist by the American Speech-Language-Hearing
Association; and

††††† 5. Before enrolling in the Kentucky
Medicaid Program, submit proof of having a Certificate of Clinical Competence
issued to the audiologist by the American Speech-Language-Hearing Association.

††††† (c) If an audiologist fails to comply
with paragraph (a) or (b) of this subsection, as applicable based on if the
audiologist is in-state or out-of-state, the:

††††† 1. Audiologist shall be ineligible to
be a Kentucky Medicaid Program provider; and

††††† 2. Department shall not reimburse for
any service or item provided by the audiologist effective with the date the
audiologist fails or failed to comply.

††††† (6)(a) An in-state specialist in
hearing instruments shall:

††††† 1. Maintain a current, unrevoked, and
unsuspended license issued by the Kentucky Licensing Board for Specialists in
Hearing Instruments;

††††† 2. Before initially enrolling in the Kentucky
Medicaid Program, submit proof of the license referenced in subparagraph 1 of
this paragraph to the department;

††††† 3. Annually submit proof of the license
referenced in subparagraph 1 of this paragraph to the department;

††††† 4. Maintain a Certificate of Clinical
Competence issued to the specialist in hearing instruments by the American
Speech-Language-Hearing Association; and

††††† 5. Before enrolling in the Kentucky
Medicaid Program, submit proof of having a Certificate of Clinical Competence
issued to the specialist in hearing instruments by the American
Speech-Language-Hearing Association.

††††† (b) An out-of-state specialist in hearing
instruments shall:

††††† 1. Maintain a current, unrevoked, and
unsuspended license issued by the licensing board with jurisdiction over specialists
in hearing instruments in the state in which the license is held;

††††† 2. Before initially enrolling in the
Kentucky Medicaid Program, submit proof of the license referenced in
subparagraph 1 of this paragraph to the department;

††††† 3. Annually submit proof of the license
referenced in subparagraph 1 of this paragraph to the department;

††††† 4. Maintain a Certificate of Clinical
Competence issued to the specialist in hearing instruments by the American
Speech-Language-Hearing Association; and

††††† 5. Before enrolling in the Kentucky
Medicaid Program, submit proof of having a Certificate of Clinical Competence
issued to the specialist in hearing instruments by the American
Speech-Language-Hearing Association.

††††† (c) If a specialist in hearing
instruments fails to comply with paragraph (a) or (b) of this subsection, as
applicable based on if the specialist in hearing instruments is in-state or
out-of-state, the:

††††† 1. Specialist in hearing instruments
shall be ineligible to be a Kentucky Medicaid Program provider; and

††††† 2. Department shall not reimburse for
any service or item provided by the specialist in hearing instruments effective
with the date the specialist in hearing instruments fails or failed to comply.

Ear Mold (One (1) Ear Mold Per Year Per Ear
and if Medically Necessary)]

V5266

Hearing Instrument Battery (Limit of Four
(4) Per Instrument When Billed With A New Hearing Instrument Or A Replacement
Instrument)

V5267

Hearing Instrument Supplies, Accessories

V5299

Hearing Service Miscellaneous (May Be Used
to Bill Warranty Replacement Hearing Instruments But Shall be Covered Only if
Prior Authorized by the Department)]

††††† Section 5. Replacement of a Hearing
Instrument. (1) The department shall reimburse for the replacement of a hearing
instrument if:

††††† (a) A loss of the hearing instrument necessitates
replacement;

††††† (b) Extensive damage has occurred necessitating
replacement; or

††††† (c) A medical condition necessitates
the replacement of the previously prescribed hearing instrument in order to accommodate
a change in hearing loss.

††††† (2) If replacement of a hearing
instrument is necessary within twelve (12) months of the original fitting, the
replacement hearing instrument shall be fitted upon the signed and dated
recommendation from an audiologist.

††††† (3) If replacement of a hearing
instrument becomes necessary beyond twelve (12) months from the original
fitting:

††††† (a) The recipient shall be examined by
a physician with a referral to an audiologist; and

††††† (b) The recipientís hearing loss shall
be re-evaluated by an audiologist.

††††† (1) A routine screening of an
individual or group of individuals for identification of a hearing problem;

††††† (2) Hearing therapy except as covered
through the six (6) month adjustment counseling following the fitting of a
hearing instrument;

††††† (3) Lip reading instructions except as
covered through the six (6) month adjustment counseling following the fitting
of a hearing instrument;

††††† (4) A service for which the recipient
has no obligation to pay and for which no other person has a legal obligation
to provide or to make payment;

††††† (5) A telephone call;

††††† (6) A service associated with investigational
research; or

††††† (7) A replacement of a hearing
instrument for the purpose of incorporating a recent improvement or innovation
unless the replacement results in appreciable improvement in the recipientís
hearing ability as determined by an audiologist.

††††† Section 7. Equipment. (1) Equipment
used in the performance of a test shall meet the current standards and
specifications established by the American National Standards Institute.

††††† (2)(a) A provider shall ensure that any
audiometer used by the provider or providerís staff shall:

††††† 1. Be checked at least once per year to
ensure proper functioning; and

††††† 2. Function properly.

††††† (b) A provider shall:

††††† 1. Maintain proof of calibration and
any repair, if any repair occurs; and

††††† 2. Make the proof of calibration and
repair, if any repair occurs, available for departmental review upon the
departmentís request.

††††† (1) Enrolled with a managed care
organization shall be in accordance with 907 KAR 17:010; or

††††† (2) Not enrolled with a managed care
organization shall be in accordance with 907 KAR 1:563.

††††† Section 10. Incorporation by Reference.
(1) The "Department for Medicaid Services Hearing Program Fee Schedule",
December 2013, is incorporated by reference.

††††† (2) This material may be inspected,
copied, or obtained, subject to applicable copyright law, at the Department for
Medicaid Services, Cabinet for Health and Family Services, 275 East Main
Street, Frankfort, Kentucky 40621, Monday through Friday, 8 a.m. to 4:30 p.m.
or online at the departmentís Web site at